Clinical Focus

  • Pediatric Hospital Medicine

Academic Appointments

  • Clinical Associate Professor, Pediatrics

Administrative Appointments

  • Associate Medical Director, Pediatric Hospitalist Program, John Muir Medical Center Walnut Creek (2015 - Present)

Professional Education

  • Board Certification: American Board of Pediatrics, Pediatric Hospital Medicine (2022)
  • Medical Education: Tufts University School of Medicine (1996) MA
  • Residency: LACplusUSC Medical Center CA
  • Internship: LACplusUSC Medical Center CA
  • Board Certification: American Board of Pediatrics, Pediatrics (1999)

Contact

  • Clinical (Primary)  John Muir Medical Center - Walnut Creek 1601 Ygnacio Valley Road Walnut Creet, CA 94598 (925) 947-4431 (fax)

Additional Clinical Info

Current Research and Scholarly Interests

clinical informatics, quality improvement

All Publications

  • Examining Infectious Complications Following Lumbar Puncture in Children. Clinical pediatrics Seddik, T. B., Burns, J. E., Chen, S. F., Schwenk, H. T., Liao, Y., Horstman, K., Waris, R., Dos Santos, L. M. 2024: 99228241293901

    Abstract

    Little is known about infectious complications of lumbar puncture (LP) in children. We reviewed records of children with bacterial meningitis, intraspinal abscess, and vertebral osteomyelitis over a 3-year period to identify infections following LP. Four children with bacterial meningitis and 1 child with vertebral osteomyelitis were identified and their clinical presentations were described. These cases were scored by infectious disease experts, using a Likert scale, for the possibility of iatrogenic causation; these scores were variable, reflecting uncertainty. The bacterial meningitis cases had repeat LPs, and the latter cerebrospinal fluid analyses were diagnostic of bacterial meningitis; the interval between the initial "index" LP (I-LP) and symptom onset was 8 to 10 hours in most cases. Pediatricians should be aware of this possibility, and have a low threshold to repeat LP if there is a clinical change after the I-LP that could be consistent with meningitis.

    View details for DOI 10.1177/00099228241293901

    View details for PubMedID 39552070

  • Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic. JAMA network open Liang, D., Wang, M. E., Dahlen, A., Liao, Y., Saunders, A. C., Coon, E. R., Schroeder, A. R. 2024; 7 (1): e2350061

    Abstract

    Urinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes.To examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity.This retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021.Time periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021).The primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis.The cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: -33.1% (95% CI, -39.4% to -26.1%) for all children and -52.1% (95% CI, -62.1% to -39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (-4.3%; 95% CI, -32.0% to 34.6% for all children) after the first 3 months of the pandemic.In this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

    View details for DOI 10.1001/jamanetworkopen.2023.50061

    View details for PubMedID 38170521

    View details for PubMedCentralID PMC10765266